Routinely using prophylactic antibiotic may not effectively prevent intervertebral disc infection: a new strategy to preventing postoperative intervertebral disc infection.

After spine surgery, intervertebral disc infection is a less common but disastrous complication. Since invasive techniques and procedures are increasingly used in the diagnosis and treatment of human disc diseases, the possibility of disc infection also increases. Today a large proportion of spinal operation is contributed to degenerative disc diseases (DDDs) in the elderly. With the degeneration of the disc, vertebral end plate undergoes sclerosis, and then the efficacy of antibiotics depends upon the permeability of the intervertebral disc, it is therefore likely that the penetration of the antibiotics is totally different in normal and degenerative discs. Antibiotics are often administrated prophylactically in spinal procedures to reduce the risk of infection of the disc space. However, the guideline for prophylactic use of antibiotics does not take into account the unique environment of intervertebral disc and the changes occurred in degenerative disc. Routinely using prophylactic antibiotic may not result in adequate antibiotic concentration in intervertebral disc to prevent disc infection, especially in DDD patients. We hypothesized that during the administration of antibiotic, prolonged lying flat on bed could decrease the internal pressure of the disc, and then increase the penetration of antibiotic into disc. According to different stages of end-plate sclerosis on MRI, combination of lying flat and increasing duration and concentration of antibiotics may be a new strategy to prevent postoperative intervertebral disc infection.